Sage Journals: Discover world-class research

Abstract

Chronic diseases tend to depend on a large number of risk factors, both environmental and genetic. Average attributable fractions were introduced by Eide and Gefeller as a way of partitioning overall disease burden into contributions from individual risk factors; this may be useful in deciding which risk factors to target in disease interventions. Here, we introduce new estimation methods for average attributable fractions that are appropriate for both case–control designs and prospective studies. Confidence intervals, derived using Monte Carlo simulation, are also described. Finally, we introduce a novel approximation for the sample average attributable fraction that will ensure a computationally tractable approach when the number of risk factors is large. An R package, $averisk$ , implementing the methods described in this manuscript can be downloaded from the CRAN repository.

Keywords

Epidemiology attributable fraction permutations weighted likelihood Monte Carlo confidence interval

Get full access to this article

View all access options for this article.

References

Levin

. The occurrence of lung cancer in man. Acta-Unio Int Contra Cancrum 1953; 9: 531–541.

Eide

Heuch

. Attributable fractions: fundamental concepts and their visualization. Stat Meth Med Res 2001; 10: 159–193.

Walter

. Prevention of multifactorial disease. Am J Epidemiol 1980; 112: 409–416.

Walter

. Effects of interaction, confounding and observational error on attributable risk estimation. Am J Epidemiol 1983; 117: 598–604.

Rowe

Powell

Flanders

. Why population attributable fractions can sum to more than one. Am J Prev Med 2004; 26: 243–249.

Smulders

Thijs

Twisk

. New cardiovascular risk determinants do exist and are clinically useful. Eur Heart J 2008; 29: 436–440.

Eide

Gefeller

. Sequential and average attributable fractions as aids in the selection of preventive strategies. J Clin Epidemiol 1995; 48: 645–655.

Ruckinger

von Kries

Toschke

. An illustration of and programs estimating attributable fractions in large scale surveys considering multiple risk factors. BMC Med Res Method 2009; 9: 7–7.

R Core Team. R: A language and environment for statistical computing, Vienna, Austria: R Foundation for Statistical Computing, 2016.

10.

Cole

MacMahon

. Attributable risk percent in case-control studies. Br J Prev Soc Med 1971; 25: 242–244.

11.

Greenland

Drescher

. Maximum likelihood estimation of the attributable fraction from logistic models. Biometrics 1993; 49: 865–872.

12.

Bruzzi

Green

Byar

et al.

Estimating the population attributable risk for multiple risk factors using case-control data. Am J Epidemiol 1985; 122: 904–914.

13.

Coughlin

Benichou

Weed

. Attributable risk estimation in case-control studies. Epidemiol Rev 1994; 16: 51–64.

14.

van der Laan

. Estimation based on case-control designs with known prevalence probability. Int J Biostat 2008; 4: Article 17–Article 17.

15.

Shapley LS. A value for n-person games. Technical Report, DTIC Document, 1952.

16.

Land

Gefeller

. A game theoretic approach to partitioning attributable risks in epidemiology. Biometr J 1997; 39: 777–792.

17.

Effron

Tibshirani

. Bootstrap methods for standard errors, confidence intervals, and other measures of statistical accuracy. Stat Sci 1986; 1: 54–77.

18.

Bakke

Eide

Hanoa

et al.

Occupational dust or gas exposure and prevalences of respiratory symptoms and asthma in a general population. Eur Resp J 1991; 4: 273–278.

19.

Eide

Heuch

. Average attributable fractions: a coherent theory for apportioning excess risk to individual risk factors and subpopulations. Biometr J 2006; 48: 820–837.

20.

Visscher

Hill

Wray

. Heritability in the genomics era - concepts and misconceptions. Nat Rev Genet 2008; 9: 255–266.

21.

Risch

Merikangas

. The future of genetic studies of complex human diseases. Science 1996; 273: 1516–1517.

22.

Grömping

Weimann

. The asymptotic distribution of the partial attributable risk in cross-sectional studies. Statistics 2004; 38: 427–438.

23.

Laaksonen

Härkänen

Knekt

et al.

Estimation of population attributable fraction (paf) for disease occurrence in a cohort study design. Stat Med 2010; 29: 860–874.

24.

Walter

. Attributable risk in practice. Am J Epidemiol 1998; 148: 411–413.

25.

Llorca

Delgado-Rodríguez

. A new way to estimate the contribution of a risk factor in populations avoided nonadditivity. J Clin Epidemiol 2004; 57: 479–483.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.49 MB

Estimating average attributable fractions with confidence intervals for cohort and case–control studies

Abstract

Keywords

Get full access to this article

References

Supplementary Material